Healthcare Provider Details

I. General information

NPI: 1073697892
Provider Name (Legal Business Name): THOMAS C. KANG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 S 320TH ST SUITE 330
FEDERAL WAY WA
98003-5400
US

IV. Provider business mailing address

2572 UNION AVE NE
RENTON WA
98059-3501
US

V. Phone/Fax

Practice location:
  • Phone: 206-400-0800
  • Fax: 523-874-9068
Mailing address:
  • Phone: 425-271-4120
  • Fax: 253-874-0968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: